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Background: Peripheral vascular disease is diagnosed by definitive history of intermittent claudication or if one or more of peripheral pulses are absent in one or both lower limbs. Diagnostic testing for peripheral vascular disease must be accurate, inexpensive, widely accessible, easy to perform and preferably non-invasive. A variety of noninvasive techniques are available to detect the presence of peripheral vascular disease as well as to localize areas of stenosis, assess severity of disease and follow patients for disease progression or response to therapy. In this study we compare the specificity and sensitivity of ankle brachial pressure index with colour Doppler ultrasound for diagnosis of peripheral vascular disease in type 2 diabetes. Methods: This prospective study was carried out in the department of General surgery, GMCH, Udaipur, Rajasthan, India, from September 2014 to February 2016 after taking the permission from institutional ethical committee. A total of 50 patients were selected. The selected patients were evaluated by detailed clinical history, physical examination, local examination, ankle brachial pressure index (ABPI), colour doppler study and other relevant investigations. The ABPI ratio was calculated in every patient and an ABPI less than 0.9 in either foot was defined to have PVD. Colour duplex ultrasound was done in all selected patients. Imaging of peripheral arteries of the lower limbs was done using high resolution colour duplex ultrasound. PVD was diagnosed if the stenosis in the artery was greater than 50% or presence of occlusion. Results: Total 50 patients having type 2 diabetes mellitus with foot infection were included and most of the patients were between 40-60 years of age (68%) with males preponderance. In our study 12 (24%) patients had normal ABPI of 1.0 to 1.29 and 22 (44%) patients were in the range of mild to moderate PVD with ABPI between 0.41 to 0.90. Colour doppler was used as a standard diagnostic test for PVD & out of 50 patients, 36 (72%) showed involvement of arteries and among them both anterior and posterior tibial arteries were involved in 12 (24%) patients. In our study colour doppler ultrasound was used as standard diagnostic method for PVD. The sensitivity, specificity, positive predictive value and negative predictive value of ABPI against colour duplex ultrasound were calculated. Conclusions: In our study it's concluded that ABPI is a good initial screening tool for peripheral vascular disease, but some patients with significant stenosis or in whom collaterals have developed in lower extremity would be missed, if ABPI measurement alone is used for diagnosis of peripheral vascular disease.

Ameloblastoma is an agressive locally recurring neoplasm of odentogenic epithelium. Here we describe a case of mandibular ameloblastoma with 12 yrs. history of local recurrences followed with history of excision twice (10 yrs. and 7 years back).

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

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BACKGROUND: Peritonitis still presents an extremely common & dreaded problem in emergency surgery. Despite aggressive surgical techniques, the prognosis of peritonitis and intra-abdominal sepsis is very poor, especially when multiple organ failure develops. Therefore early objective & reliable classification of the severity of peritonitis and intra-abdominal sepsis is needed not only to predict prognosis & to select patients for these aggressive surgical techniques but also to evaluate & compare the results of different treatment regimens. So, in this prospective study of 60 cases of peritonitis, the reliability of the Mannheim peritonitis index is assessed & its predictive power evaluated. MATERIALS & METHODS: This prospective study was carried out in the department of surgery, GMCH, Udaipur from June 2014 to June 2015 after taking the permission from institutional ethics committee. Patients from both sexes of various age groups having peritonitis of varied aetiology & who had undergone laparotomy were taken. A detailed history, thorough clinical examination & necessary investigations were performed in each case according to planned proforma. After resuscitation laparotomy was done & operative findings were noted carefully and a proper note on the progress of each patient was maintained and any complications encountered were noted. So, early classification of patients presenting with peritonitis by means of objective scoring system was done to select patients for aggressive surgery & overall morbidity & mortality were analyzed. RESULTS: Total 60 patients of peritonitis were examined and common causes were peptic (61.6%), typhoid (21.6%) and appendicular (8.3 %). Most common age group was found to be 21 to 50 years and male to female ratio was 4:1. Peritonitis was more common in patients involved in hard work and chronic Bedi smokers (61.6%). About 46% of patients who presented for treatment within 48 hours of onset of illness mortality was 0% compared to 25% in those who presented after 8 hours. Overall mortality rate was 13.3%. It was highest in the 2 nd decade (25%) followed by the 5 th , 6 th , 7 th decade (16.6% each) of life. Mortality steadily increased with increased in Mannheim peritonitis index score. For patients with a score less than 21 the mortality rate was 0%, for score 21-29 it was 14.2 % and for score greater than 29 the mortality rate was found to be 50%. Patients with a score less than 26 the mean mortality rate was 2.3% and for score greater than 26, it is 38.8%. For a threshold index score of 26, the sensitivity was 87.5% and specificity was 78.8% in predicting death. CONCLUSION: This study reaffirms the value of the Mannheim Peritonitis index in identifying high risk patients with peritonitis.